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Emphysema​

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Emphysema Overview

Emphysema belongs to a group of diseases called chronic obstructive pulmonary disease (COPD).

This long-term and progressive disease of the lungs causes shortness of breath. It destroys the tissues necessary to support the shape and function of the lungs.

Causes of emphysema

  • Smoking: Smoking tobacco products can contribute to the destruction of the tiny air sacs in your lungs (alveoli). The more you smoke, the more likely you are to develop emphysema.
  • Alpha-1 antitrypsin deficiency: Rarely, a deficiency of the substance known as Alpha-1 antitrypsin can cause emphysema. Typically, people inherit this type of COPD.

Other rare causes of COPD include:

  • Exposure to toxic gases and fumes in the workplace.
  • Exposure to significant amounts of secondhand smoke.
  • Living in a heavily polluted environment.
  • Frequent use of a fire for cooking or heat without proper ventilation.

When emphysema worsens, your air sacs — normally spherical in shape — contort into large, irregular pockets.

These pockets of destroyed air sacs:

  • Leave gaping holes in their inner walls.
  • Reduce the surface area of the lungs available for gas exchange.
  • Diminish the amount of oxygen in your bloodstream.

Over time, emphysema destroys the elastic fibers that hold the bronchioles (tiny airways that lead to the air sacs) open.

When this happens, the airways collapse when you exhale. Consequently, the lungs cannot expel carbon dioxide to make room for fresh air.

Learn more about COPD in our Health Library:

Contact Us

Contact the UPMC Esophageal and Lung Surgery Institute with questions or for more information.
Or, call the Thoracic and Foregut Surgery Division at 412-647-7555.

Emphysema Symptoms and Diagnosis

The symptoms of emphysema and other chronic obstructive pulmonary diseases (COPD) develop slowly. Most people don't realize they have the condition until these symptoms worsen.

When symptoms do become apparent, they can include:

  • Wheezing
  • Frequent respiratory infections
  • Fatigue
  • Cough — with or without mucus
  • Shortness of breath
  • Trouble catching your breath

Diagnosing emphysema

Doctors use a variety of tests to diagnose emphysema.

One of the best COPD diagnostic tools is a lung function test called spirometry.

For this test, the doctor will ask you to blow out as hard as you can into a device that measures lung capacity. The test results are available immediately.

Unlike some other diagnostic procedures, during spirometry, you don’t need to:

  • Exercise
  • Wait for results
  • Have exposure to radiation

Your doctor may also:

  • Order an arterial blood gas test to measure the amount of oxygen and other gases in your bloodstream.
  • Use a stethoscope to listen to your lungs as you breathe, but sometimes lungs sound normal even in people who have emphysema.
  • Order x-rays or a CT scan of your lungs. While these can prove helpful, lungs may look normal even with emphysema present, especially with an x-ray image. That’s why doctors consider spirometry the most reliable tool for diagnosing COPD.

Learn more about COPD symptoms and tests in our Health Library:

Contact Us

Contact the UPMC Esophageal and Lung Surgery Institute with questions or for more information.
Or, call the Thoracic and Foregut Surgery Division at 412-647-7555.

Emphysema Treatments

Chronic obstructive pulmonary disease (COPD) represents the fourth leading cause of death in the United States. However, effective treatment options do exist.

Although treatment cannot reverse damage from emphysema, it may slow the progression of the disease. If you smoke, the single most effective treatment involves quitting smoking.

Non-surgical treatment and therapies for emphysema

  • Smoking cessation program to slow disease progression
  • Breathing assistance machine (BiPAP)
  • Medicine:
    • Inhaled steroids to reduce inflammation
    • Inhaled bronchodilators to open airways (Atrovent, Spiriva, Serevent, albuterol)
    • Anti-inflammatory medications, such as Montelukast (Singulair) and roflumilast
    • Oral or intravenous steroids
    • Oxygen therapy
    • Antibiotics for flare-ups to prevent infection

The experts at the UPMC Esophageal and Lung Surgery Institute also provide surgical options for people with emphysema.

Lung volume reduction surgery (LVRS) for emphysema

Some people with emphysema may have areas of the lung that are more affected than others. The LVRS procedure removes up to 35 percent of the poorly functioning lung tissue from each lung.

By removing this space-occupying tissue, the remaining relatively healthy lung tissue and surrounding muscles can work more efficiently. This allows for easier breathing and helps people with emphysema enjoy a better quality of life.

UPMC is one of the only hospitals in the United States approved to perform this life-enhancing procedure. In fact, James Luketich, MD is a pioneer in both minimally invasive surgery techniques and LVRS specifically.

At the Esophageal and Lung Surgery Institute, you have a team of medical specialists and allied professionals all in one location. There’s no need to travel from facility to facility for testing, rehabilitation, and surgery.

It’s a comprehensive, collaborative program that offers the best opportunity for those with emphysema to enhance their quality of life and improve their health status overall.

LVRS criteria and preliminary testing

You may want to consider LVRS if your emphysema greatly impacts your quality of life.

If you have: Then:
Emphysema located mainly in the upper lobe of the lung(s) and a low exercise capacity, You may benefit the most from this surgery.
A high exercise capacity and upper lobe predominant emphysema, You may qualify for LVRS, but the impact on mortality is not as significant.
Non-upper lobe predominant emphysema and decreased exercise capacity, Surgeons — in select cases — may agree to perform LVRS. It’s important to check with your doctors to see if you may qualify as a candidate in this case.

It’s important to know the strict criteria necessary to qualify for LVRS.

You must have stopped smoking for a minimum of four months to undergo preliminary testing for LVRS. Prior to preliminary diagnostic tests, doctors will order tests that will show if you’ve used tobacco products in the past four months.

Medical risk assessment

A key factor in determining eligibility for LVRS involves undergoing careful medical risk assessment testing. These preliminary tests determine whether you are likely to survive the surgery and thrive after the operation.

Some of the preliminary tests include:

  • CT scan — to look at the lungs carefully and determine if you have a clear-cut delineation of emphysema in the upper lobe region of the lung(s), or if the emphysema appears spread throughout the tissue.
  • Routine pulmonary function testing — to establish baseline lung function.
  • Ventilation/perfusion scan — uses scintigraphy, or medical isotopes, to evaluate the circulation of blood and air in a person’s lungs. This test will help doctors better establish upper lobe predominance of emphysema.
  • Arterial blood gas test — to establish oxygen and carbon dioxide levels in the blood.
  • Exercise test — may include a six-minute walk with standard protocols to measure how much work your body can perform.
  • Cardiac testing — after the above preliminary tests, you’ll likely have an echocardiogram and a cardiac stress test.

What to expect during LVRS

Before surgery, once you’ve passed all the preliminary testing and qualified for the LVRS procedure:

  • Your doctor will enroll you in a pulmonary rehabilitation program.
  • The therapists working in the program will assign an exercise regimen to enhance cardiopulmonary status.

After minimally invasive LVRS, you will:

  • Typically stay in the hospital between five and seven days.
  • Should feel quite good by about two weeks after the operation.
  • Return to your pulmonary rehabilitation program where therapists will work with you to greatly enhance your cardiopulmonary status through specialized exercise programs.

Lung transplant surgery for emphysema

A lung transplant may represent an option for those with very advanced (end stage) disease or disabling emphysema symptoms.

UPMC's Lung Transplant Program is one of the most recognized and experienced centers in the world. This expertise allows us to accept many people as lung transplant candidates that other centers may decline.

Learn more about COPD treatments in our Health Library:

Contact Us

Contact the UPMC Esophageal and Lung Surgery Institute with questions or for more information.
Or, call the Thoracic and Foregut Surgery Division at 412-647-7555.

Life Changing Is ... Robert's Deep Breath

Surgery at UPMC helped Robert overcome his COPD and emphysema and improve his quality of life.

Read Robert's story.